Dr Anne Merriman: The Champion of Palliative Care in Uganda And Africa

The access to medicine fraternity in Uganda and most of African countries continue to pay tribute to Professor. Anne Merriman, the Irish physician who championed palliative care for the critically ill.

She is credited to have been behind a model that was duplicated for roll out of palliative care not just in Uganda but in several African countries. Anne Merriman died at her home in Munyonyo on Sunday aged 90.  

She was the founder of Hospice Africa providing palliative care to several African countries including Uganda.     She had hoped to live to see all African Governments and people providing palliative care for those at home as well as in hospital. But that dream was cut short as she took her last breath in Uganda where she has been since 1993.             

The Ambassador of Ireland to Uganda and Rwanda, Kelvin Coulgan in message said Dr Anne Merriman was the embodiment of Caring and Compassion, and her life is a testament to the vision of Hospice “palliative care for all those in need in Africa”

“She worked tirelessly for over 30 years to spread this vision across the continent! Ar dheis Dé go raibh a hanam” reads the message.     

Prossy Nakyanja , Executive Hospice Africa Uganda said Anne will be missed by all. “Our love comes from God, and our compassion comes from the example of a Good Samaritan. Compassion is such an important thing for us, not only in work, but also with each other" she said.       

Dr. Stephen Watiti, who has worked with Anne Merriman in the fights against HIV/AIDS in Uganda wrote on his X handle that. 

“RIP my Friend & Mother Dr. Anne Merriman, founder of Hospice Africa Uganda. Glory to God for a life well lived, serving others. Without palliative care I wouldn’t have survived the onslaught of TB, Cancer & Meningitis in 1999. Fare well, your work lives on” said Dr. Stephen Watiti, who has lived with HIV for over thirty years.

Dr. Anne Merriman’s name was and will forever be ingrained in the book of some of the individuals that championed for care and support of persons who were infected with the HIV virus and suffering from cancer in Uganda.

Many remember that by 1993, Uganda’s cancer rate was on the increase. Karposi’s Sarcoma, a marker for AIDS, was the most common form of cancer and treatments such as antibiotics or anti-fungal agents were scarce and only available for the rich.

Imagine a world where the only pain relief is paracetamol   

Dr.  Anne Merriman was fond of that quotation whenever she was addressing gatherings about the importance of morphine in the management of the terminally ill cancer patients and those living with HIV/AIDS in Uganda and elsewhere in Africa. 

She once share with this Journalist. “This quotation is really immense for the Western world. Well they can’t believe that that could ever happen. But in fact in 1993 in Nigeria when we did the first study. We met a woman in agony. And the hospital where she had been for treatment, I had worked in it in the 60’s, it had everything. And now it had nothing except paracetamol. And I had to let her go home in agony” shared Merriman.   

////Cue In” And that was happening all over….. 

Cue Out……something”////

At the peak of the HIV/AIDS pandemic in Uganda, Professor, Anne Merriman had just settled in Nairobi Kenya as the firs medical director of Nairobi Hospice.

She had set up palliative care services in Singapore.   “And I realized the terrible situation of people who were going home without any pain control. There was nothing more that could be done” said Merriman in her characteristic soft tone.              

///Cue In “And it was a much         

Cue Out….early 1993.”///       

The pain for those with infections was huge and yet there was little hope for most patients. It has equally been documented that as late as 2000, the strongest pain killer was paracetamol.  Stronger pain killers like codeine was available only to the rich as it was expensive.           

Professor Merriman then approached the then Health Minister, Dr.  James Makumbi seeking for a policy directive on introduction of simply made oral morphine.          

“Because I said can’t start palliative care unless I had paid control for severe pain and cancers” she narrated.   Morphine was at the time only permitted for only cancer pain and yet people with the HIV/AIDS and related ailments were dying in pain.    

“By September 1993, we had imported morphine. And since then, we have never run out of morphine. At the beginning it was made in Nsambya hospital, but we have been making it ourselves in the hospice since 1995,” she revealed.   The preparation of morphine has since been rolled to other parts of the country. Those initiatives have paid off by availing affordable morphine to the patients be it those suffering from different types of cancer or those living with HIV/AIDS. It costs about four thousand shillings for a two –week pain control for an average patient.  

Support Care with Pain care? 

Unfortunately in some countries the use of morphine has been kept outreach to those that need it. Some have tended to associate it with additives. However Anne Meriman was always quick to defend its use in Palliative Care insisting that helps the patient and the family to holistically made the suffering. 

///Cue In “The Funny thing is that ….

Cue Out….after they die”/// 

“Because support care without pain control is just care. It is very essential and it is very good. But once you meet a patient in severe pain, you really can’t give them that care”    

She shared that she and the colleagues got a lot of challenges initially because a lot of people thought it was addictive and some thought they were killing their patients with morphine.              

“In fact, our patients lived longer because they were on pain control. And we even had people go back to work. I had a policeman who directed traffic on his morphine. And we had farmers going back to doing their work” she said.               

In 1995, the Hospice Africa team were invited to Mbarara to teach palliative care to medical students at the Mbarara University of Science and Technology. Hospitals like Kitovu have been administering morphine mainly for person living with HIV/AIDS.  

 

As she gets laid to rest, the key message is the need to increase resources in healthcare services so that death is not accompanied by avoidable pain and other distressing symptoms.   

For now , it is widely noted that  governments in many countries including Uganda usually give care at the end of life a low priority compared with preventive and curative services .

A requiem in her honor will be held in Nsambya at midday on Wednesday. The body will then be transported to the Hiindu temple in Kampala for cremation.